Confusable diagnoses · PANCE / PANRE

Asthma vs Cystic Fibrosis

Asthma and Cystic Fibrosis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Asthma vs Cystic Fibrosis at a glance

  • Asthma: Chronic reversible airway inflammation with episodic bronchoconstriction.
  • Cystic Fibrosis: Autosomal recessive CFTR dysfunction causing thick secretions, lung disease, and pancreatic insufficiency.
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Side-by-side comparison

FeatureAsthmaCystic Fibrosis
At a glanceChronic reversible airway inflammation with episodic bronchoconstriction.Autosomal recessive CFTR dysfunction causing thick secretions, lung disease, and pancreatic insufficiency.
Classic presentationWheezing that improves with short-acting beta-agonist; nocturnal cough; symptom relief between episodes.; Episodic wheeze, cough (often nocturnal), chest tightness, dyspnea; Triggered by allergens, exercise, cold air, viral URIs, NSAIDs, beta-blockers, emotional stress; Diurnal variation: worse at night and early morning; Expiratory…Neonatal: meconium ileus (10-20%), failure to thrive, prolonged jaundice; Pulmonary: chronic productive cough, recurrent pneumonia, sinusitis, nasal polyps, wheeze, exercise intolerance, hemoptysis, clubbing; GI: bulky greasy foul-smelling stools, malabsorption (fat-soluble vitamin deficiencies A, D, E, K), distal intestinal obstruction…
Workup / key labsGINA: history of variable respiratory symptoms + confirmed variable expiratory airflow limitation (bronchodilator reversibility, methacholine positivity, or PEF variability).; CBC (eosinophilia supports allergic phenotype); Total IgE and allergen-specific IgE if considering biologics or ABPA; FeNO (fractional exhaled nitric oxide) —…CF Foundation 2017: clinical features OR positive newborn screen OR sibling history PLUS evidence of CFTR dysfunction — sweat chloride ≥60 mmol/L (two tests) OR two disease-causing CFTR mutations OR abnormal nasal potential difference.; Sweat chloride test (pilocarpine iontophoresis) — diagnostic gold standard: ≥60 mmol/L on two…
ImagingCXR — usually normal or hyperinflation; obtain to exclude alternative diagnoses or complications (pneumothorax, pneumonia); HRCT if bronchiectasis or alternative diagnosis suspectedHRCT chest — bronchiectasis (upper lobe predominant in CF), mucus plugging, air trapping; CXR — hyperinflation, peribronchial thickening, atelectasis; Abdominal imaging if DIOS or biliary disease
First-line treatmentGINA 2024 has eliminated SABA-only treatment; all adults and adolescents should receive ICS-containing therapy; Step 1-2 (mild): low-dose ICS-formoterol PRN (preferred 'MART' approach) — budesonide-formoterol or beclomethasone-formoterol; Step 3 (moderate): low-dose ICS-LABA daily + ICS-formoterol PRN as reliever; Step 4: medium-dose…CFTR modulator therapy — disease-modifying, transformative:; Elexacaftor/tezacaftor/ivacaftor (Trikafta) — for ≥2 years with ≥1 F508del or other responsive mutation; >85% of patients now eligible; Ivacaftor — for gating mutations (G551D and others); Tezacaftor/ivacaftor, lumacaftor/ivacaftor — earlier-generation combinations; Airway…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.